Sharma Sunil, Mather Paul, Gupta Ankit, Reeves Gordon, Rubin Sharon, Bonita Raphael, Chowdhury Anindita, Malloy Raymond, Willes Leslee, Whellan David
Division of Pulmonary and Critical Care, Department of Internal Medicine, Jefferson Sleep Disorders Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
Division of Cardiology, Department of Internal Medicine, Advanced Heart Failure and Cardiac Transplant Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
Am J Cardiol. 2016 Mar 15;117(6):940-5. doi: 10.1016/j.amjcard.2015.12.032. Epub 2015 Dec 31.
Rehospitalization for congestive heart failure (CHF) is high within 6 months of discharge. Sleep disordered breathing (SDB) is common and underdiagnosed condition in patients with CHF. We hypothesized that early recognition and treatment of SDB in hospitalized patients with CHF will reduce hospital readmissions and emergency room visits. Patients admitted for CHF underwent overnight polysomnography within 4 weeks of discharge. Patients diagnosed with SDB were provided therapy with positive airway pressure therapy. Patients were identified as having good compliance if the device use was for a minimum of 4 hours 70% of the time for a minimum of 4 weeks during the first 3 months of therapy. Hospital admissions for 6 months before therapy were compared with readmission within 6 months after therapy in patients with good and poor compliance. A total of 70 patients were diagnosed with SDB after discharge. Of the 70 patients, 37 (53%) were compliant with positive airway pressure therapy. Compliant patients were more likely to be older (64 ± 12 vs 58 ± 11 years) and women (54% vs 33%) and less likely to be patient with diabetes (40% vs 67%) versus noncompliant patients. Although both groups experienced a decrease in total readmissions, compliant patients had a significant reduction (mean ± SE: -1.5 ± 0.2 clinical events vs -0.2 ± 0.3; p <0.0001). In this single-center analysis, identification and treatment of SDB in admitted patients with CHF with SDB is associated with reduced readmissions over 6 months after discharge. Adherence to the treatment was associated with a greater reduction in clinical events.
充血性心力衰竭（CHF）患者出院后6个月内再次住院的比例很高。睡眠呼吸障碍（SDB）在CHF患者中很常见且诊断不足。我们假设，对住院的CHF患者早期识别和治疗SDB将减少再次住院和急诊就诊次数。因CHF入院的患者在出院后4周内接受了夜间多导睡眠图检查。被诊断为SDB的患者接受了气道正压通气治疗。如果在治疗的前3个月中，设备使用时间至少达到4周，每周至少70%的时间使用时间不少于4小时，则患者被确定为依从性良好。比较了治疗前6个月和治疗后6个月内依从性良好和依从性差的患者的住院情况。共有70例患者出院后被诊断为SDB。在这70例患者中，37例（53%）依从气道正压通气治疗。与不依从的患者相比，依从的患者年龄更大（64±12岁对58±11岁），女性更多（54%对33%），患糖尿病的可能性更小（40%对67%）。尽管两组的再次住院总数均有所下降，但依从的患者有显著下降（平均值±标准误：-1.5±0.2次临床事件对-0.2±0.3次；p<0.0001）。在这项单中心分析中，对患有SDB的CHF住院患者识别和治疗SDB与出院后6个月内再次住院次数减少相关。坚持治疗与临床事件的更大减少相关。
